Evaluation of Frailty Measures and Short-term Outcomes After Lung Transplantation

Swaminathan, Aparna; McConnell, Alec; Peskoe, Sarah B.; Bashir, Mustafa R.; Buckley, Erika Bush; Frankel, Courtney W.; Turner, Daniel J.; Smith, Patrick J.; Zaffiri, Lorenzo; Singer, L.G.; Snyder, L.D.

doi:10.1016/j.chest.2023.01.017

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…We consider that the difference with our study cohort could be explained by different methods used: in our study we consider a muscle index normalized by BSA, while in the paper of Kelm et al a pure muscular tool (i.e., measure of muscle surface area) was considered [54]. Recently, Swaminathan et al in a cohort of 515 LT recipients conducted a frailty assessment, and thoracic sarcopenia was one of variable investigated [55]. In that cohort of study, a prevalence of 51.3% of frail patients according to the transplant-specific frailty index was reported, but no association was found between thoracic sarcopenia and short-term outcomes after LT [55].…”

Section: Discussionmentioning

confidence: 97%

“…Recently, Swaminathan et al in a cohort of 515 LT recipients conducted a frailty assessment, and thoracic sarcopenia was one of variable investigated [55]. In that cohort of study, a prevalence of 51.3% of frail patients according to the transplant-specific frailty index was reported, but no association was found between thoracic sarcopenia and short-term outcomes after LT [55]. Recently, a growing interest has been reported on the assessment of frailty in solid organ transplantation recipients and in LT candidates, as reported by the paper of Singer et al which proposed the Lung Transplant Frailty Scale (LT-FS) as a disease-specific physical frailty measure with higher predictive capability of delisting/death face [56].…”

Section: Discussionmentioning

confidence: 99%

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Nutritional and Sarcopenia Assessment in Bilateral Lung Transplantation Recipient: Can “The Strongest One” Expect Improved Short-Term Outcomes?

Congedi,

Boscolo,

Nardelli

et al. 2023

Transplantology

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Background: Scant data are available on nutritional status in bilateral lung transplant (BLT) candidates. Methods: All consecutive recipients admitted to the intensive care unit (ICU) of the University Hospital of Padua (February 2016–2020) after bilateral-lung transplant (BLT) were retrospectively screened. Data collected: (i) nutritional indices (body mass index (BMI), albumin level, prognostic nutritional index (PNI), mini nutritional assessment short-form (MNA-SF)); and (ii) muscular indices (creatinine height index (CHI)), skeletal muscle index (SMI), densitometry of paravertebral muscles on chest CT). Results: 108 BLT recipients were enrolled: 55% had a normal BMI, 83% had serum albumin levels > 35 g/L; high PNI and MNA-SF scores were recorded in most of patients. A total of 74% had a “normal or slightly reduced protein state“ according to the CHI score; 17% were identified as “sarcopenic” according to muscle densitometry (Hu < 30). Lower serum albumin was associated with longer invasive mechanical ventilation days (IMV) and ICU length of stay (p-value for non-linearity < 0.01). PNI and BMI were also associated with an increased ICU length of stay (p-value for non-linearity < 0.01). Conclusions: Most of the BLT recipients had normal nutritional and sarcopenia status. Pre-transplant albumin values correlated with the duration of IMV; serum albumin, PNI and BMI were associated with ICU stay. No nutritional or muscle parameters predicted re-intubation, 30-days rejection and overall length of hospital stay.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Nutritional and Sarcopenia Assessment in Bilateral Lung Transplantation Recipient: Can “The Strongest One” Expect Improved Short-Term Outcomes?

Congedi,

Boscolo,

Nardelli

et al. 2023

Transplantology

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“…Agreement between the FI and another frailty tool (such as the FFP or Short Physical Performance Battery, which are commonly used and already validated in the transplant literature), was not tested because it has been established in the general population as well as the transplantation population that frailty tools derived from different models identify different groups of patients as frail and the correlation between the tools is poor. 27,[36][37][38] Feasibility was assessed using descriptive statistics. An independent t-test and Wilcoxon ranked sum were used to compare the means and medians of continuous variables between interviewed and noninterviewed groups.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients?

Weerasekera,

Reid,

Young

et al. 2023

Transplantation Direct

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Background. Clinical Practice Guidelines suggest that frailty be measured during kidney transplant eligibility assessments. Yet it is not known how frailty is best assessed in this setting or whether its assessment is acceptable to patients. We aimed to examine the construct validity and feasibility of Frailty Index (FI) assessment among patients attending a kidney transplant assessment clinic and to explore patients’ perspectives on frailty and the acceptability of its routine assessment. Methods. A 58-item FI was calculated for 147 clinic patients. Semistructured interviews were conducted with a subgroup of 29 patients. The FI was validated against normative FI characteristics (mean, distribution, limit), age, and the Estimated Post-Transplant Survival Score. Feasibility was assessed using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis. Results. The mean FI was 0.23 (±0.10, normal distribution, limit 0.53). FI increased with age and Estimated Post-Transplant Survival score. The FI was completed for 62.8% of eligible patients (147/234). The median completion time was 10 min, and completion rate (with no missing data) was 100%. Four themes were identified: perceptions of frailty, acceptability, perceived benefits, and risks of frailty measurement. Patients linked frailty with age and adverse outcomes, and most did not consider themselves frail. Patients reported that the FI was quick, simple, and efficient. They felt that frailty assessment is relevant to transplant eligibility and should be used to address potentially reversible factors. Conclusions. The FI demonstrated construct validity and was feasible and acceptable in this clinic setting. The challenge is ensuring that routine assessments lead to better care.

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“…It has also become apparent that sarcopenia (loss of muscle quantity and quality) and frailty (slowness, weakness) associated with end-stage organ failure are common in transplant candidates and affect candidacy for transplant, survival while waiting for a transplant, and postoperative outcomes. [10][11][12][13][14][15][16] Malnutrition, sarcopenia, and frailty are related and overlapping conditions that, when assessed before transplant, can be viewed as modifiable risk factors that could be attenuated to help improve posttransplant outcomes. Being able to correctly identify at-risk groups can help clinicians decide on the necessity of initiating nutrition support and physical therapy treatments in the pretransplant as well as acute posttransplant phase.…”

Section: Pretransplant Nutrition Statusmentioning

confidence: 99%

Nutrition support management of organ transplant recipients in the acute posttransplant phase

Hahn,

Wood,

Hasse

2023

Nut in Clin Prac

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Patients who undergo solid organ transplant can have an extensive and challenging postoperative course. The chronicity of the disease state prior to transplant in combination with transplant‐specific complications and immunosuppressant medications can lead to distinct challenges that are not observed in other critically ill patients. Although the manifestation of posttransplant complications may be specific to the organ being transplanted, there are common transplant challenges that affect nutrition therapy in these patients. Effects of malnutrition, metabolic aberrations, and posttransplant organ dysfunction should be considered when developing a nutrition care plan for patients in the immediate posttransplant phase. This article addresses the various complications that can arise in the immediate posttransplant phase among patients undergoing solid organ transplant and the appropriate nutrition interventions or considerations for this specialized patient population.

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Evaluation of Frailty Measures and Short-term Outcomes After Lung Transplantation

Cited by 8 publications

References 31 publications

Nutritional and Sarcopenia Assessment in Bilateral Lung Transplantation Recipient: Can “The Strongest One” Expect Improved Short-Term Outcomes?

Nutritional and Sarcopenia Assessment in Bilateral Lung Transplantation Recipient: Can “The Strongest One” Expect Improved Short-Term Outcomes?

Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients?

Nutrition support management of organ transplant recipients in the acute posttransplant phase

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